Several treatments can help with Seasonal Affective Disorder

Winter blues

Therapeutic light boxes can be effective in the treatment of Seasonal Affective Disorder.

While many Coloradans look forward to winter -- skiing! -- a small subset dreads the colder, darker months: those who have Seasonal Affective Disorder.

Fittingly enough, the condition is abbreviated SAD, but also nicknamed winter blues. Symptoms for SAD in winter include sleeping more, eating more and craving carbohydrates, weight gain, irritability, sensitivity to rejection and what's known as leaden paralysis -- a leaden feeling in the arms and legs.) How many people experience SAD? Studies have shown some variation, but a 1989 phone survey reported in the Archives of General Psychiatry found that 4 to 6 percent of respondents reported fall SAD, with another 10 to 20 percent reporting a milder form. Much rarer is summer SAD, with symptoms that include decreased appetite, weight loss and insomnia.

While winter SAD is believed to be caused by the reduction of light in winter, no studies have actually proven causation. Theories are that the change in light disrupts circadian rhythm, and/or the neurotransmitter serotonin or the hormone melatonin. Antidepressants and psychotherapy are often prescribed. However, a first-line treatment for the reduction of SAD is light therapy.

Turning it on

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Light therapy or phototherapy consists of using a specially designed light box for a specified time every day. The light, which can be purchased online, and the dosage should be discussed with psychiatrist or other practitioner who specializes in Seasonal Affective Disorder. Lights range from 2,500 to 10,000 lux. According to the Mayo Clinic, the lights should screen out UV rays and differ from light therapy used for skin conditions. A typical dose of light is to sit 4 feet away for 30 minutes, but that amount and distance may be too little or too much. Results may be evident in as little as a week. For those who know they have SAD, light treatment is often started in September and used through the winter and early spring.

Side effects can include anxiety and irritability that can usually be reduced by adjusting the intensity or duration of the light. A more serious side effect is hypomania that can happen to people who have bipolar disorder.

Light, naturally

Dr. Michael Weissberg, professor in psychiatry at the University of Colorado School of Medicine and the medical director of the Sleep Program at Boulder Community Hospital, used to recommend light boxes for patients with SAD. But he says there can be problems with using the light at the right time of day and in the right amount. Figuring that out can be complicated by people who have a delayed circadian rhythm.

Weissberg now suggests daily exercise outside during the winter months. He says depression can make people less active and engaged, which makes their condition worse.

"What you find is that patients, especially when they're depressed, don't go outside. Basically, they turn into mushrooms," he says. "When you go outside, you're getting a lot of light. Go outside for 45 minutes. Walking outside will help immeasurably."

Diet and

supplements Cat Pantaleo, lead practitioner, and a certified herbalist and clinical nutritionist at Pharmaca, also suggests exercise.

"There are so many studies linking regular physical exercise with mood elevation," she says. "The results are pretty remarkable."

She says that due to Boulder's prevalent sunshine she sees many times fewer people for SAD than she did when she worked in the Northwest.

"It's rampant (there)," she says.

Her first approach is to focus on diet and nutritional deficiencies.

"Food is the best medicine," she says.

She recommends reducing refined carbs, which she says tend to lower energy, mental clarity and focus. Abundant fruits and vegetables, as well as a high quality protein are important, as well. She recommends a supplement of green minerals by Healthforce, which she says promote energy without stressing the adrenal gland.

"It's a great supplement even for people who eat really well," she says. "Nutritional deficiencies are key in many mood disorders ... and anxiety."

Pantaleo also suggests Vitamin D supplementation, if levels test low, as well as the B vitamins. Fish oil or a good source of vegetable Omega 3 fatty acids is her final supplement recommendation.

Herbs and

adaptogens

For those who continue to have depressed mood or anxiety, she suggests St. John's wort or lemon balm. However, St. John's is contraindicated if a person is also taking antidepressants, she says.

If energy is an issue, she also suggests an adaptogen such as rhodiola or eleuthero.

Acupuncture

Valerie Hobbs, director of Program Development at Southwest Acupuncture College in Boulder, says acupuncture can be effective for depression, including Seasonal Affective disorder.

She says ear acupuncture would likely be the most affective for SAD.

"We may see (a patient) frequently in the beginning," she says. "The treatment has an effect after the needles are removed. With the frequency of treatments, the length of the effect is longer."

That means the treatments might start at twice a week and decrease in frequency to a maintenance regime of four times a year.

"The idea is eventually we want to have somebody return to normal function and not be dependent on acupuncture," she says.

If symptoms present with the change of season, treatments would again become more frequent.

"They have an exterior trigger that's not going to go away," she says.

Hobbs adds that the studies she has read on acupuncture and depression apply to mild or moderate cases. For those with severe depression, she recommends concurrent treatment with other practitioners such as psychiatrists or psychotherapists.

"With very severe depression, they do need to be monitored," she says, adding that those who receive acupuncture along with the other treatments do better than those who don't receive acupuncture as a complementary therapy.

"(Acupuncture) really does change the brain chemistry," she says.

Ayurveda

Ayurveda, an ancient system of medicine originating thousands of years ago in India, is based on the idea that all people are made up of five elements: space, air, fire, water and earth. The elements combine into doshas or life forces that describe how an individual's body functions. The three doshas are Vata (space and air), Pitta (fire and water) and Kapha dosha (water and earth).

Rohini Kannighanti, an ayurvedic specialist and medical doctor who works with geriatric homebound patients at House Call Physicians in Longmont, says seasonal variation is less pronounced in India.

However, she says Boulder, with its dryness, high altitude and frequent strong winds increases the air element or Vata. Further, October to December, which is cold, dry and windy, also corresponds with Vata, which means that in the fall and early winter, it's easy for those who have a predominantly Vata constitution to get out of balance.

To promote healing, she suggests sunlight, but not staring at lights. Nutrition-wise, warm, cooked moist foods.

"Stews are wonderful," she says, as are warming spices and sweet, sour and salty tastes, which are associated with the grounding earth element.

Good, regular sleep and gentle exercise such as walking and yoga are also a good idea.

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